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Title: A Risk-benefit Analysis of Prophylactic Anticoagulation for Patients with Metastatic Germ Cell Tumours Undergoing First-line Chemotherapy.
Austin Authors: Fankhauser, Christian Daniel;Tran, Ben;Pedregal, Manuel;Ruiz-Morales, José Manuel;Gonzalez-Billalabeitia, Egon;Patrikidou, Anna;Amir, Eitan;Seidel, Christoph;Bokemeyer, Carsten;Hermanns, Thomas;Rumyantsev, Alexey;Tryakin, Alexey;Brito, Margarida;Fléchon, Aude;Kwan, Edmon M;Cheng, Tina;Castellano, Daniel;Del Muro, Xavier Garcia;Hamid, Anis A;Ottaviano, Margaret;Palmieri, Giovanella;Kitson, Robert;Reid, Alison;Heng, Daniel Y C;Bedard, Philippe L;Sweeney, Christopher J;Connors, Jean M
Affiliation: University Hospital Zurich, University of Zurich, Zurich, Switzerland
Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Olivia Newton-John Cancer Wellness and Research Centre
Peter MacCallum Cancer Centre, Melbourne, Australia
Tom Baker Cancer Centre, Calgary, Alberta, Canada
Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
Hospital Universitario Morales Meseguer-IMIB, UCAM, Murcia, Spain
The Royal Marsden NHS Foundation Trust, London, UK
Department of Oncology, Hematology, BMT with Division of Pneumology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
University Hospital Zurich, University of Zurich, Zurich, Switzerland
NN Blokhin Russian Cancer Research Centre, Moscow, Russia
Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
Centre Léon Bérard, Lyon, France
Institut Catala d'Oncologia, Idibell, University of Barcelona, Barcelona, Spain; Department of Oncology, Hospital Universitario 12 de octubre, Madrid, Spain
Institut Catala d'Oncologia, Idibell, University of Barcelona, Barcelona, Spain
CRTR Rare Tumors Reference Center, Università Degli Studi di Napoli Federico II, Naples, Italy
The Royal Marsden NHS Foundation Trust, London, UK
Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
Issue Date: Sep-2021 2020-10-05
Publication information: European urology focus 2021; 7(5): 1130-1136
Abstract: It remains unclear which patients with metastatic germ cell tumours (mGCTs) need prophylactic anticoagulation to prevent venous thromboembolic events (VTEs). To assess the risk and onset of VTEs stratified by risk factors. This multi-institutional retrospective dataset included mGCT patients treated with first-line platinum-based chemotherapy. Patients with prophylactic anticoagulation were excluded. A regression analysis was performed to select risk factors for VTEs. The simulated number needed to treat (NNT) and the number needed to harm (NNH) with prophylactic anticoagulation were calculated based on the cumulative incidences retrieved from this study and hazard rates of recently published trials describing the efficacy of prophylactic anticoagulation to prevent VTEs and the risk of bleeding events. From 1120 patients, 121 (11%) had a VTE, which occurred prior to chemotherapy in 49 (4%) and on or after chemotherapy in 72 (6%). Six patients (<1%) had a bleeding event without anticoagulation. After backward regression, the one risk factor for a VTE during or after chemotherapy was the use of a venous access device. The simulated cumulative VTE incidence from prophylactic anticoagulation for patients on or after chemotherapy would translate into an NNT of 45 (95% confidence interval [CI] 36-56) and an NNH of 186 (95% CI 87-506). Limitations are mainly related to the retrospective nature of the study. The mGCTs associated VTEs are most common before and during, but not after, chemotherapy. Avoiding venous access device and/or prophylactic anticoagulation with an acceptable risk-benefit profile may decrease VTE occurring on chemotherapy. We found that venous thromboembolic events (VTEs) occur rarely after chemotherapy. Based on experience of prophylactic anticoagulation in other cancers, we conclude that the risk of VTE in men undergoing chemotherapy for metastatic germ cell tumours can be decreased by thromboprophylaxis with a reasonable risk-benefit profile and by avoidance of venous access devices.
DOI: 10.1016/j.euf.2020.09.017
PubMed URL: 33032968
Type: Journal Article
Subjects: Deep vein thrombosis
Germ cell tumour
Pulmonary embolism
Testicular cancer
Venous access device
Venous thromboembolism
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